Age-related difference in extraocular muscles and its relation to clinical manifestations in an ethnically homogenous group of patients with Graves’ orbitopathy
Age-related difference in extraocular muscles and its relation to clinical manifestations in an ethnically homogenous group of patients with Graves’ orbitopathy
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DOI：
10.1007/s00417-021-05377-9
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发表时间：
2021-09
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通讯作者：
Yuning Su;Xingtong Liu;S. Fang;Yazhuo Huang;Yinwei Li;Sisi Zhong;Yang Wang;Shuo Zhang;Huifang Zhou;Jing Sun;Xianqun Fan
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文献类型：
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作者：
Yuning Su;Xingtong Liu;S. Fang;Yazhuo Huang;Yinwei Li;Sisi Zhong;Yang Wang;Shuo Zhang;Huifang Zhou;Jing Sun;Xianqun Fan
目的通过计算机断层扫描（CT）测量EOMs，探讨EOMs的年龄相关性差异及其与临床表现的关系。方法对40例（80个眼眶）中重度Graves眼病患者的病历及CT影像资料进行回顾性分析。患者分为两组，1组（≤40岁）和2组（≤40岁）。同时获得了30名性别和年龄相匹配的正常对照者的CT扫描结果。测量各外膜的最大横截面积（MCA）和位置（pMCA）。结果组1术后复视发生率较高（p< 0.001），组2术后复视发生率较高（p< 0.001）。第2组更容易发生生产过程中的运动受限（p= 0.027），且严重程度更高（p= 0.047）。在组1中，pMCA在下直肌（p= 0.001）、内侧直肌（p= 0.021）和外侧直肌（p= 0.013）较高。在两组患者中，斜视与pMCA呈正相关，复视与MCA呈正相关。限制水平与MCA（高级，r= 0.467,p< 0.001；低级，r= 0.358,p= 0.007；内侧，r= 0.314,p= 0.018；外侧，r= 0.308,p= 0.021）或pMCA（低级，r= - 0.534,p< 0.001）之间仅在组2中有显著相关性。结论老年和年轻患者的肌肉扩张模式有显著差异。老年患者往往眶后肌腹增大，导致更多的复视和运动受限。突出更可能受到最大位置而不是肌肉大小的影响。因此，年轻的患者往往会出现更多的突出，即使肌肉扩大，也不会受到运动限制的困扰。
PurposeTo evaluate the age-related difference in EOMs and its relation to clinical manifestations by computed tomography (CT) measurement of EOMs.MethodsThe medical records and CT image review of 40 patients (80 orbits) with moderate-to-severe Graves’ orbitopathy were performed. The patients were divided into two age groups, group 1 (≤ 40 years) and group 2 (> 40 years). CT scans of 30 gender- and age-matched normal controls were also obtained. The maximal cross-sectional area (MCA) and its position (pMCA) of each EOM were measured.ResultsGroup 1 presented with more severe proptosis (p< 0.001), while group 2 had a higher risk of diplopia (p< 0.001). Motility restriction in supraduction was more likely to occur in Group 2 (p= 0.027) with even higher severity (p= 0.047). The pMCA was higher in the inferior (p= 0.001), medial (p= 0.021), and lateral rectus (p= 0.013) in group 1. Proptosis was positively correlated to pMCA while diplopia was correlated to MCA in both groups. Significant correlation was noted between restrictions levels and MCA (superior,r= 0.467,p< 0.001; inferior,r= 0.358,p= 0.007; medial,r= 0.314,p= 0.018; lateral,r= 0.308,p= 0.021) or pMCA (inferior,r= − 0.534,p< 0.001) only in group 2.ConclusionsThe muscle enlargement patterns are significantly different between younger and older patients. Older patients tended to have enlarged muscle bellies more posterior in the orbit, which is responsible for more diplopia and motility restriction. Proptosis is more likely to be affected by the most enlarged position than muscle size. So younger patients tended to develop more proptosis and be less bothered by motility restriction even with enlarged muscles.